Interventional Cardiology Fellowship Program Details

The fellow should understand and be proficient in all areas of General Cardiology prior to beginning the fourth year. These skills must be reviewed and utilized during the fourth year so that fellows continue to be excellent Cardiologists as they are learning the field of interventional cardiology.

The fellow will understand appropriate patient selection for invasive and interventional cardiac procedures. The fellow will understand specific device and technique selection for interventional procedures.

The fellow must understand contraindications and potential complications of all invasive and interventional procedures and be able to communicate these with patients and other physicians.

The fellow will understand cardiac and vascular system anatomy including possible anatomical variants and pathological states.

The fellow will be familiar with the performance and indications for all forms of interventional therapy and will be exposed to and proficient at most of these procedures. Interventional procedures currently performed at our institution include percutaneous transluminal coronary angioplasty (PTCA), intracoronary stent placement, rotational atherectomy, directional atherectomy, alcohol septal ablation for IHSS, Aortic and mitral balloon valvuloplasty, renal artery angioplasty and stenting, iliac artery angioplasty and stenting. Other related procedures include intra-aortic balloon pump (IABP) insertion, temporary transvenous pacemaker insertion, and pericardiocentesis.

The fellow will be able to interpret hemodynamic and angiographic data obtained during invasive and interventional procedures.

The fellow will gain experience in the pre- and post-care of patients undergoing invasive and interventional procedures.

The fellow will understand the limitations of interventional techniques and proper patient selection for cardiovascular surgical procedures.

The fellow will be able to integrate data from the diagnostic and interventional procedures as well as non-invasive data to form a thoughtful, correct, and cost effective treatment plan.

The fellow will understand basic radiation physics and safety with respect to cardiac catheterization laboratory equipment.

The fellow will understand the proper use of iodinated contrast agents and avoidance of toxicity. The fellow will understand the differences between ionic and non-ionic contrast agents.

The fellow will understand the processes of restenosis after coronary procedures as well as the process of disease progression. The fellow will understand current ways to prevent restenosis and disease progression.

Method of TeachingMost of the teaching in the fourth year is “hands-on” experience with conference and didactic teaching that complements the learning experience. In most cases, the fellow will perform a history and physical on the patient and review available non-invasive data. This is done to help decide if the procedure is indicated and to plan effective treatment strategy. The attending and fellow will then discuss the case to make sure there is agreement on plans. During invasive and interventional procedures, both the attending and fellow are “scrubbed in” and stand side by side performing the procedure. This gives the opportunity for ongoing discussion of the procedure, techniques, and results. After procedures are completed, the fellow and the attending review the data generated and the results obtained to plan the continuing care of the patient. The fellow will communicate with other housestaff involved in the care of the patient and will be essential in educating other residents and fellows about invasive and interventional procedures. Fellows will have the opportunity to follow-up patients after invasive and interventional procedures in the outpatient setting.

Conferences related to cardiology are held almost daily. Cardiac catheterization conference is held weekly. All aspects of cardiac catheterization are discussed during this conference which is geared toward all of the cardiology fellows and is attended by fellows, cardiology attendings, and cardiovascular surgery attendings. This conference has a varied format. Some cath conferences focus on a single procedure or disease process. The fellow presents the patient history and physical and appropriate ancillary data and cardiac catheterization data. The fellow then presents the relevant research data on the topic. Attendings or fellows who have relevant comments or data or questions add to the discussion. Some cath conferences center on a complicated case in which the audience is encouraged to help decide management of the patient. Other cath conferences are “show-and-tell” where several interesting cases are shown with brief discussion about each. There will be a new conference starting with the first group of fourth year fellows entitled Interventional Conference. In this conference we will review most of the recent interventional cases to discuss approach used, device and equipment selection, results, and complications. This conference will be attended by the interventional fellows, the interventional program director, and available interventional attendings. Other conferences held on a regular basis within the division are: Interesting Case Conference (weekly ), Echocardiography Conference (weekly), General Cardiology Conference/Board Review (weekly). Also, the Department of Medicine holds a weekly Grand Rounds conference.

B. Patient CharacteristicsThe Medical University of South Carolina is both a tertiary referral center and a major local hospital serving Charleston and surrounding communities. Patients are generally over the age of 18, with no real upper limit on age. Patients younger than 18 are occasionally seen because of our international status in the treatment of Hypertrophic Obstructive Cardiomyopathy (HOCM / IHSS). Fellows will be exposed to “bread and butter” community cardiology problems through admissions from the emergency room and referrals from community physicians, as well as encountering rare cardiac problems referred from around the Southeast and the world.

C. Types of Clinical EncountersInterventional Fellows will have interaction with patients before, during, and after procedures in both the outpatient and inpatient settings. For outpatients scheduled for an invasive procedure, the fellow will take a directed history and physical, explain the procedure to patients and family, answer questions, and make sure patients is properly prepared for the procedure. The fellow performs the invasive / interventional procedure with the attending. The fellow is the responsible for the post care of the patients including medication adjustment and discharge planning. For inpatients, the fellow reviews the available data and prepares the patient for the procedure. The fellow is encouraged to follow these patients throughout their hospitalization to assess the response to the therapy. Fellows will see patients in the outpaitient setting for general cardiology problems and also to decide appropriate interventional therapy before procedures and to follow short and long-term results after procedures.

ProceduresA wide variety of procedures are performed at our institution.

ResearchFellows will be required to perform research. Each fellow will conceive an idea for a clinical study and will write the protocol, obtain appropriate IRB approval (if necessary), perform study/collect data, and write up the study for submission for publication. This will be done with a faculty advisor. Most of the interventional faculty are actively involved in clinical research and have multiple projects ongoing. The fellows are encouraged to get involved in these studies as well.

Ancillary Educational MaterialFellows are expected to stay current in the field by reading cardiology journals including JACC, AHJ, Circulation, AJC, Catheterization and Cardiovascular Intervention, as well as other relevant journals. Several excellent textbooks are recommended for fellows, including: Heart Disease by Braunwald, The Heart by Hurst, Cardiac Catheterization, Angiography and Intervention by Grossman and Baim, Diagnostic and Therapeutic Cardiac Catheterization by Pepine, Strategies in Coronary Interventions by Ellis, and Hemodynamic Rounds by Kern, among others.

Each fellow is encouraged to attend one of the major interventional conferences during the year. If funding is available, the division will send the fellows to either the TCT conference or the ACCIS conference.

Evaluations

Method of Evaluations of FellowsEach fellow in the interventional year will be evaluated on a quarterly basis just like the general cardiology fellows. All attendings who have worked with the fellows during that period will submit a written evaluation. The program director will review evaluations and discuss them with the fellow. If problems are isolated at any time during the rotation, the fellow will be counseled as to the appropriate changes needed to ensure successful completion of their training.

Method of Evaluation by FellowsEach fellow is required to submit a written evaluation of each attending he/she has worked with during the rotation. This is submitted anonymously, and each attending receives an evaluation compiled from all of the fellows. The education experience of the rotation is also evaluated and if appropriate, changes are made to better the education experience. After completion of the fellowship program, the fellows are encouraged to write and overall assessment of the program both positive and negative so that we may continuously improve the training program to continue to turn out well trained interventional cardiologists.